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9/18/12 A Guide to Geriatric Nursing Assessment In A Skilled Nursing Care Center Instructor: Christine O’Rourke BSN, RN, MSN, FNP-C This module has been prepared for the ongoing education of registered nurses. Nursing autonomy of practice and nursing career development places a priority on a lifelong commitment to the principles of education and professional development. The knowledge base of nursing theory and practice is expanding and while care has been taken to ensure the accuracy and timeliness of the information presented in this module and series, clinicians are advised to always verify the most current national guidelines and recommendations and to practice in accordance with professional standards of care used with regard to the unique circumstances that apply in each practice situation. Therefore, the authors, presenters, producers and consultants of this educational module cannot accept responsibility for error or omissions, or for any consequence or liability, injury and/or damages to persons or property from application of the information in this module/series and make no warranty, expressed or implied, with respect to the contents. MODULE 7 • Heart BASE APEX 1 9/18/12 HEART Purpose & Function • A muscle that contracts and relaxes rhythmically to insure proper circulation of blood to the body for survival • 4 chambers • RT/LT atria BASE • RT/LT ventricles APEX • 2 atrioventricular valves • Tricuspid • Mitral • 2 semilunar valves • Pulmonic • Aortic HEART Purpose & Function • Autonomous • SA node • AV node • Bundle of His • Purkinje fibers • Cardiac Cycle • Systole • Diastole HEART Geriatric Changes • • • • • Heart size decreases Left ventricular wall thickens Valves fibrose and calcify Heart rate slows Delayed myocardial contractility 2 9/18/12 PHYSICAL ASSESSMENT Inspection Heart • Apical impulse • Midclavicular line • 5th left intercostal space • Skin • Cyanosis or venous distention • Nail beds • Cyanosis and capillary refill time PHYSICAL ASSESSMENT Palpation Heart • Apical Impulse - gentle & brief • Sequence • Apex • Left sternal border • Base • PMI • Thrill • Carotid pulse • Synchronous with S1 PHYSICAL ASSESSMENT Auscultation Heart • 5 cardiac areas • Aortic valve – 2nd right intercostal space at right sternal border • Pulmonic valve – 2nd left intercostal space at left sternal border • Second pulmonic – 3rd left intercostal space at left sternal border • Tricuspid – 4th left intercostal space along lower left sternal border • Mitral (apical) – 5th left intercostal space at the midclavicular line, at the apex 3 9/18/12 PHYSICAL ASSESSMENT Auscultation Heart • Heart Sounds • S1 - closure of the AV valves, beginning of systole, heard best toward apex, lower in pitch and longer than S2 • S2 - closure of the semilunar valves, end of systole, heard best in aortic and pulmonic area, higher pitch and shorter than S1 The Auscultation Assistant – Heart Sounds http://www.wilkes.med.ucla.edu/ See post test # 7 document REFERENCES • Seidel, H., Ball, J., Dains, J., & Benedict, W. (2006). Heart. Mosby’s Guide to Physical Examination. 414-458. 4